GLP-1 receptor agonists shown effective in older adults with obesity, with caveats

A new meta-analysis indicates that GLP-1 receptor agonists such as liraglutide and semaglutide remain effective for weight loss and glycaemic control in adults aged 65 and over, though closer monitoring for side effects like constipation and hypoglycaemia is advised. The study highlights the potential of these drugs to address obesity in older populations while emphasising the need for tailored clinical caution.

A meta-analysis published in Obesity suggests that GLP-1 receptor agonists can be used in older adults with obesity without a major loss of efficacy, while still requiring closer monitoring for side effects such as constipation and hypoglycaemia. The review brought together randomised and observational evidence in people aged 65 and over, comparing them with younger adults, and found broadly similar weight loss and glycaemic benefits across age groups.

The study is notable because older adults have often been under-represented in obesity trials, even though obesity is rising in later life and can overlap with sarcopaenia, the age-related loss of muscle strength and mass. That makes weight loss in this group more complicated than in younger patients: reducing fat may help cardiometabolic risk, but excessive loss of lean tissue or bone density could be harmful. The authors therefore examined not only body weight and HbA1c, but also adverse events and, in one study, body composition.

Across the studies reviewed, serious adverse events were not meaningfully different between older and younger participants. Gastrointestinal effects were mixed: nausea, vomiting and diarrhoea were broadly comparable, but constipation was more common in older adults, and hypoglycaemia was also higher in this group, particularly in studies involving patients with type 2 diabetes. The review found no clear difference in weight loss, and glycaemic improvement was also similar overall, suggesting that age alone should not rule out treatment. One observational study led by Perna found that liraglutide reduced body fat while showing only limited change in measures linked to muscle loss, although the authors note that the lack of a control group weakens that conclusion.

The findings fit with a broader body of evidence that has strengthened the case for semaglutide and related drugs in cardiometabolic disease. In the SELECT trial, which enrolled patients with overweight or obesity and established cardiovascular disease, semaglutide 2.4mg cut major cardiovascular events by 20%, a benefit that appeared independent of baseline HbA1c in later analyses. The new review adds a more age-specific message: GLP-1 drugs appear effective in older adults, but clinicians should pay particular attention to bowel symptoms, low blood sugar and the possibility of frailty-related harms, especially where treatment is combined with other glucose-lowering drugs.